Segmental thoracic spinal anesthesia versus general anesthesia for breast cancer surgery: A prospective randomized-controlled open-label trial

Abstract

Background and Aims: Breast surgery is associated with moderate-to-severe postoperative pain, nausea, and vomiting. For this, neuraxial anesthesia might be a better alternative to general anesthesia (GA), providing superior analgesia, with higher patient satisfaction and lesser incidence of nausea vomiting. This randomized-controlled open-label trial was done to compare segmental spinal and GA for breast cancer surgery. Material and Methods: The present study enrolled 56 female patients scheduled to undergo breast cancer surgery. They were randomly divided into two groups, group G (received standard GA) and group TS (received segmental thoracic spinal anesthesia with 0.5% isobaric levobupi vacaine at T5–T6 inter spaces). The primary objective of this study was patient satisfaction with the anesthetic technique, while secondary objectives were hemodynamic changes, perioperative complications, time of first rescue analgesic, total opioid consumption in first 24 h, and surgeon satisfaction score. Data were expressed as mean (SD) or number (%) as indicated and were compared using Chi-square, Fisher’s exact, or Student’s ttest as appropriate. Results: Patient in group TS had significantly higher satisfaction score median 5 (IQR 1) compared to patients in group G median 4 (IQR 3.5) (P = 0.0001). Nausea and vomiting were significantly higher in group G compared to group TS (P = 0.01). Mean time to rescue analgesia was 33.21 ± 7.48 min in group G as compared to 338.57 ± 40.70 in group TS and opioid consumption was also significantly lower in group TS (70.00 ± 27.38) as compared to group G (366.07 ± 59.40). There was no significant difference in hemodynamic parameters (except significantly lower heart rate at 15 min in group TS (P = 0.001) and surgeon satisfaction score between groups. Quality of postoperative analgesia was better in group TS. Conclusion: Segmental thoracic spinal anesthesia technique provides better satisfaction with superior postoperative analgesia and fewer complications in patients undergoing breast cancer surgery compared to GA.

Effectiveness of Segmental Thoracic Spinal Anaesthesia in Breast Surgery: An Observational Study

“…However, segmental spinal anesthesia in the thoracic level remains the most controversial technique amongst anesthesiologists due to the fear of spinal cord injury. Paliwal et al 2 Chandra et al 14 and Elakany 23 have provided some evidence that segmental spinal anaesthesia can be used for breast surgeries. This study reveals that thoracic spinal anaesthesia can be used to provide a segmental block sufficient enough to perform breast surgeries in ASA I and II patients.…”

“…General anesthesia is currently the standard technique used for breast surgery 1,2 . However it has various disadvantages which include, but not limited to, inadequate pain control due to a lack of residual analgesia, higher stress response, higher incidence of nausea and vomiting, and increasing the length of hospitalization 3,4,5 .…”

“…There is currently renewed attention to thoracic segmental spinal anaesthesia for several common surgeries 10,11 . It has been used for patients undergoing surgery with major medical problems and demonstrated as a safe and effective method for various surgeries including breast and abdominal cancer surgery [1][2][3] . However, there is significant debate regarding this practice around the world.…”

Anaesthetic Management for Mastectomy in a Male With Unilateral Gynecomastia: The Utilization of Thoracic Segmental Spinal Anaesthesia and Erector Spinae Plane Block

“…The lowest block level in this case scenario was T7, which suggests no motor blockade in the lower limbs, improving patient satisfaction. With a significantly lower incidence of postoperative nausea and vomiting than general anaesthesia, thoracic segmental spinal anaesthesia has several advantages over it, including improved patient comfort, hemodynamic stability, decreased opioid use, early mobilisation, and efficient pain management [12]. However, it is essential to be aware of the possible side effects of segmental spinal anaesthesia.…”

Recent advancements in regional anaesthesia

“…Mastering the technique of segmental SA can help in the anaesthesia management of critically ill patients with comorbidities, considering the risk-benefit ratio over general anaesthesia. Few studies including RCTs on segmental TSA have shown that it provides better patient satisfaction with superior postoperative analgesia and fewer complications in breast cancer surgery compared to GA.[ 32 ] Nonetheless, evidence on the technique including case reports is steadily building up and it shows that TSA may be used in patients where other anaesthetic techniques pose a higher risk of mortality. [ 33 ] Well-designed RCTs on TSA in different population groups need to be conducted in the future.…”